In 2021 and 2022, Aetna and Episcopal Health Foundation (EHF) collaborated to learn more about food security, centering on the everyday challenges people face while trying to meet their food needs. Departing from conventional methods, this partnership embraced a solution-oriented perspective. This Digging Deeper post is part of a blog series exploring this journey from different viewpoints.
Dr. Belanger and her colleagues, Professors Emmerentie Oliphant and Lenola Wyatt, are social workers by training. They used the Positive Deviance approach to learn what practices set social service providers whose clients achieved unexpected success apart from the typical provider. By understanding these practices, they hope to help spread them through their roles as educators and municipal leaders.
I’m a researcher. I look at facts, patterns, differentiating what is the truth from distraction. I take great pains to be sure my sample is representative, my questions are good, unbiased, etc. When I was introduced to Dr. Arvind Singhal’s concepts of PD by my colleagues Emmerentie Oliphant and Lenola Wyatt I was intrigued. PD asks simple questions: Why do we get good outcomes when everything would lead us to expect otherwise? What is actually working? Why is it working? How can we replicate it? PD begins by looking at the outliers, solutions to challenges that we know can work because someone is actually “doing it”.
Dr. Oliphant and Professor Wyatt used this approach to learn about social service providers in Deep East Texas, wanting to understand the practices that set apart providers whose clients achieved unexpected success from others. They started by asking the providers to identify peers whose clients experienced excellent outcomes, overcoming enormous challenges, few resources and limited expectations for success becoming self-sufficient. These providers identified their peers who made real differences in the lives of clients, linking them with out of the ordinary or extra-ordinary client outcomes.
When those providers were identified, we asked them to tell us specifically about their process in working with clients—how they talked with them, where they met with them. We asked the providers to show us, to treat us like the client. We asked them what they really did, not just what they wrote down, or what they thought we wanted to hear.
And we learned that instead of working quickly, instead of following steps in textbooks, if we wanted to see extraordinary outcomes, if we wanted to replicate work that resulted in stability, we needed to sit a spell.
All providers identified taking the time to listen to clients first. “We used to interrupt before they were finished” asking questions and redirecting clients to fill out the forms. Now several providers simply listen to the stories, to the issues, the needs and fill in forms on behalf of the client. As a result, providers gather much more information while instilling confidence that the client is heard.
And the time given to clients is not just 8 to 5. Giving time after normal work hours assures that the providers are listening, and that the clients are worth listening to. They found that giving clients time to tell the whole story saved time; clients provided information more relevant to their challenges with less backtracking, becoming partners in problem solving. And taking the time to really listen is at the heart of the Positive Deviance approach itself—allowing participants to speak without interruption, gleaning their insights.
They found that giving clients time to tell the whole story saved time; clients provided information more relevant to their challenges with less backtracking, becoming partners in problem solving.
What a simple thought—to take all the time necessary to listen! Following the example of our stellar human services providers, taking the time to listen well has made us better researchers, teachers, even better elected officials.
So first, we sit a spell.
More from Digging Deeper
EHF’s Journey to Learn About and Pilot Positive Deviance Studies
A promising approach to uncover uncommon behaviors and practices in addressing food insecurity
Reflections on Positive Deviance: Sit a Spell
Professors in the School of Social Work at Stephen F. Austin University used the Positive Deviance approach to learn what practices set social service providers whose clients achieved unexpected success apart from the typical provider.
Lessons Learned: Greater Houston Area – Accountable Health Communities APM Planning Project
The Accountable Health Communities (AHC) Model was a 5-year Center for Medicare and Medicaid Services (CMS) Innovation Center project (running May 2017 to April 2022) that tested whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries’ has an impact on healthcare utilization.